Tag Archives: Celiac disease

Credit: Pixabay.

New gluten biomarker may lead to an easy blood test for diagnosing celiac disease

A new study has uncovered what the very first signs of inflammation look like at the molecular level when celiac sufferers ingest gluten. The newly identified biomarkers could someday lead to a quick and easy blood test for diagnosing celiac disease without the massive hassle current tests involve.

Credit: Pixabay.

Credit: Pixabay.

Gluten” is an umbrella term used to denote the mix of storage protein compounds found in all species and hybrids of wheat and its related grains (barley, rye, etc).

Some people can have gluten intolerance, sometimes referred to as non-celiac gluten intolerance (NCGI) or gluten sensitivity, or suffer from celiac disease (CD). The latter is much worse because it is an autoimmune disorder which causes the celiac disease sufferer’s body to violently react to the presence of gluten — to the point where their immune system will attack the inner lining of the small intestine to ‘protect it’ from gluten. About 1 in 100 people are affected by celiac disease.

If you suffer from CD, there’s not a cure per se. Patients with celiac disease have to eliminate all gluten from their diets, medicines etc. If you are gluten intolerant (not celiac), then you will get by with consuming gluten from time to time without too much discomfort (depending on just how intolerant you are).

The problem is that it’s not so straightforward differentiating between CD and gluten intolerance. And diagnosing celiac disease is not comfortable, to make an understatement.

In order to diagnose CD, doctors will look at several blood biomarkers that are telltale signs of the disease. However, many patients switch to a gluten-free diet long before they go to a doctor for diagnosis, and these biomarkers will have inevitably declined by the time a blood test is scheduled.

What usually happens is the patient is made to eat a gluten diet for several weeks in order to trigger a detectable response and allow for a clear diagnosis — but hopefully not for long.

A new study has discovered that a specific type of cytokine — special proteins made by the immune system — floods the bloodstream following exposure to gluten. This particular cytokine, called interleukin-2 (IL-2), is produced by immune T cells within just two hours of exposure to gluten.  This means that a blood test looking for this biomarker could diagnose CD within the same day that gluten was ingested by the patient.

“For the many people following a gluten-free diet without a formal diagnosis of coeliac disease, all that might be required is a blood test before, and four hours after, a small meal of gluten,” said Jason Tye-Din, head of coeliac research at the Institute and a gastroenterologist at The Royal Melbourne Hospital in Australia.

“This would be a dramatic improvement on the current approach, which requires people to actively consume gluten for at least several weeks before undergoing an invasive procedure to sample the small intestine,” he added.

The authors hope that in the future the way CD is being diagnosed and treated will never be the same.  Elsewhere, ImmusanT is working on a vaccine called Nexvax2,  which when administered in multiple doses can reprogram T-cells to stop triggering a pro-inflammatory response. In other words, this vaccine might someday allow CD suffers to follow an unrestricted diet. The CD vaccine is specifically designed to work against the HLA-DQ2.5 genetic form of the disease, which accounts for 90 percent of people with celiac.

“It is clear this research has the potential to revolutionize the current testing regime for coeliac disease globally,” says Michelle Laforest, CEO of Celiac Australia.

The findings appeared in the journal Science Advances.

Credit: Pixabay.

Vaccine might allow Celiac disease patients to eat gluten

About 1% of the global population suffers from celiac disease, an autoimmune disorder that damages the small intestine when a person ingests gluten. But a new treatment currently in phase II clinical trials may change all that, allowing people with the disorder to include gluten in their diets.

Credit: Pixabay.

Credit: Pixabay.

Celiac disease is hereditary and causes the immune system to respond against gluten, which are proteins found in wheat, barley, and rye. For reasons that are not completely understood, ingesting gluten makes the body see the intestine as foreign and attacks it with an inflammatory reaction.

Besides damage to the intestines, the immune response also blocks nutrients from being absorbed properly in the body. Other symptoms include abdominal pain, bloating, diarrhea, constipation, headaches, bone or joint pain and chronic fatigue.

Right now, the only thing a person with celiac disease can do to stay safe is to cut out gluten entirely from their diets. The disorder is so severe that even trace amounts of wheat or rye can trigger an immune response. In the future, however, people with celiac disease might be able to live a normal life thanks to an innovative new treatment.

[panel style=”panel-success” title=”The difference between celiac disease and gluten intolerance” footer=””]There is a difference between celiac disease (CD) and gluten intolerance. Things get even more complicated if you add gluten allergies in the mix, which is another distinct condition related to gluten.

Unlike celiac disease, both gluten sensitivity and gluten intolerance do not cause damage to the lining of the small intestine. The body does, however, identify gluten as a foreign invader which triggers the launch of an immune response. Unfortunately, 83% of people with celiac disease are undiagnosed or misdiagnosed because the signs and symptoms with other conditions are so similar. [/panel]

Nexvax2 is a vaccine meant to protect people with celiac disease from inadvertent gluten exposure and to allow patients to follow an unrestricted diet. The vaccine is specifically designed to work against the HLA-DQ2.5 genetic form of the disease, which accounts for 90 percent of people with celiac.

According to ImmusanT, the manufacturer of Nexvax2, the vaccine is administered in multiple doses that reprogram T-cells to stop triggering a pro-inflammatory response.

In September, the first patient received a dose of a vaccine. Now, Immusant is starting a phase II clinical trial involving 150 participants from the U.S., Australia, and New Zealand. Over the course of 16 weeks, researchers will steadily increase the dose of the vaccine and will follow how patients response to gluten proteins in the gut.

Phase II trials typically last around two years. If all goes well, the therapy can enter phase III, where researchers need to demonstrate that vaccine is at least as safe and effective as currently available options. Finally, if the treatment passes this phase, it may apply for FDA approval so it can be made available to patients in the United States.

Wheat.

What is gluten and why some people have gluten intolerance

“Gluten” is an umbrella term used to denote the mix of storage protein compounds found in all species and hybrids of wheat and its related grains (barley, rye, etc). Not a single substance but rather a mixture of various kinds of protein, gluten is, simply put, the way these cereals store building materials for the future.

Wheat.

*gluten intensifies*
Image credits Hans Braxmeier.

Owing to proteins’ tendency to bunch up or string together, gluten lends elasticity and texture to baked goods, making them either chewy or crunchy — “gluten” is actually the Latin word for “glue”. It’s also the object of many a fad diet and legitimate dietary concerns (primarily in the shape of allergies or intolerances), and a cool compound to use in making DIY playdough.

What is gluten made of

So right off the bat, gluten doesn’t have a set chemical structure. Its composition varies depending on the species in question and the exact percentages very likely differ from individual to individual. But in a general sense, gluten is a mixture of prolamins and glutelins.

Prolamins are a family of storage proteins used to stockpile (mainly) proline and glutamine, two amino acids which underpin protein synthesis for plants. Each crop produces and stores a different brand of prolamin — gliadin in wheat, hordein for barley, secalin in rye, zein in corn, kafirin in sorghum, and avenin (minor protein) in oats. Glutelins do basically the same thing as prolamins in chemically-different combinations and shapes. They’re rich in amino acids, particularly glutenin (wheat), though to a lesser overall degree than prolamins.

Proline&Glutamine.

The two amino acids gluten mainly stores.

All plants use protein stores of one kind or another, mostly concentrated in fruits in the case of endosperms, earmarked to supply budding plants during germination. The term gluten is sometimes extended to these stores as well (especially for corn or rice as they’re also cereals) but true gluten (with prolamins and glutelins) is only found in wheat, its related grains, and their species and hybrids. Some other gluten-free grains you’re likely to bump or bite into are quinoa, amaranth, and oats — although this last one is usually not recommended by dietitians, as it’s usually processed through the same channels as wheat-related grains, which can contaminate it with gluten.

Why gluten is good

Proline is considered to be a non-essential amino acid in the human body (the need can be covered by internal synthesis), while glutamine plays a non-essential/conditionally essential role (it is usually supplied by the body’s own synthesis processes, but must be supplemented by diet in certain stressful conditions). Glutamine has the distinction of being the most abundant free amino acid in the bloodstream.

So while they do have nutritional value, for the most part, our bodies don’t really need these amino acids. But gluten plays a central part in how we process and then consume grains. It accounts for the lion’s share of proteins in bread — anywhere between 75 to 80% — so to understand what it does, let’s take a quick look at how these behave.

Bread.

Those stretch-like marks are made by gluten holding the dough together during yeast fermentation.
Image credits Lebensmittelfotos.

Proteins are essentially long chains of amino acids strewn together and folded into certain shapes. They do all sorts of stuff in living bodies, such as pumping compounds in and out of cells or moving things around. But the thing we’re interested in right now is that they are also the go-to compounds when mechanical resilience and stiffness are required. Your nails are so hard compared to your skin because they’re rich in keratin. Your nose never breaks because elastin strands hold the cartilage together, just like the iron rods do in reinforced concrete. Cells keep their shape because tiny filaments of protein run from wall to wall and prop them up.

And that’s what gluten does in pretty much any foodstuff made from flour. By kneading it with water, bakers “weave” gluten into long elastic strands which act similarly to those of a polymer. These strands are made up of glutenin molecules which criss-cross into a microscopic net-like pattern along with gliadin (wheat glutenin) molecules, making the dough hold together, feel a bit rubbery, and stretchable. Heat treatment such as baking or boiling breaks the folding in gluten and makes it coagulate, which, along with starch, gives bread its mechanical properties. Gluten has also been identified as playing a part in the staling of bread, likely by binding atmospheric water molecules.

To get an idea of the physical properties of gluten and how it ties food together, you can play around with a lump of pure gluten. It’s quite fun — keep your hands clean and (most of) you can eat it afterward, too. If you don’t have any lying around, tofu is a similar product (soy/plant proteins but with a higher % of fat mixed in) which is more widely available.

What is gluten intolerance

Now, my reaction to hearing about a new fad diet is a wide smile and a knowing, paternal chuckle. And a big part of the demand for gluten-free products comes down to just that — a fad. To each his own (wallet) but, considering a number of foodstuffs that have gluten and their nutritional value, going gluten-free without any medical reason isn’t the best of ideas as it could end up making your diet way worse overall.

At least some people have a sense of humor about it.
Image credits William Murphy / Flickr.

That being said, some people who are gluten-sensitive or gluten-intolerant can’t eat gluten. There are several gluten-related disorders: celiac disease (CD) is the most common form of intolerance, then there’s the still-debated-on non-celiac gluten sensitivity (NCGS), and a slew of other nasty reactions from dermatitis herpetiformis and irritable bowel syndrome (IBS) to gluten ataxia and wheat allergy. People suffering from CD see their bodies produce an abnormal immune response when digesting gluten, making their digestive tract unable to absorb nutrients. About 18 million Americans have gluten sensitivity, according to the National Foundation for Celiac Awareness. Those with NCGS exhibit many of the same symptoms, due to poor digestion or a placebo effect, still under debate. So why does this happen?

The first thing you have to keep in mind is that while humans are omnivores, our bodies just aren’t geared to eating absolutely everything out there — but we’re very good at adapting. Certain populations overcome diet limitations over time through contact with traditional types of food.

For example, Western society as a whole is much less lactose intolerant than the rest of, well, mammals, since in nature milk is reliably on the menu only before weaning — after that, it’s highly unlikely to pop up, so mammalian bodies don’t maintain a stock of lactase because it doesn’t make economic sense for them to do so. But most westerners today have acquired lactose resistance through (relatively few) generations of natural selection for the ability to eat dairy, as milk was an important source of nutrients here. Writing in the New York time on this subject, Moises Velasquez-Manoff said:

“Few Scandinavian hunter-gatherers living 5,400 years ago had lactase persistence genes, for example. Today, most Scandinavians do.”

The “we’re not yet adapted to it” approach has a lot of support, and there may be some limited validity to that point of view in certain cases. We know of grain consumption even before agriculture, albeit on a reduced scale. It’s also likely that those cereals were poorer in gluten or might not have employed it all together (such as is the case with wild oats), meaning there was no reason to adapt to eating a lot of grains by that time. There is evidence tying CD to genetic factors. However, I’d say that adaptation similar to the one above led to a greater digestibility of gluten and likely worked up a natural tolerance for the majority of humans — else people wouldn’t have eaten it for like 23,000 years.

One other factor cited to play a hand in gluten intolerance is that selective breeding of wheat and related crops up to modern times led to increasing levels of ATIs (-α-amylase/trypsin inhibitors), which the plants use to fight off insects but also interfere with the digestive tract’s processing of gluten, and our bodies are still catching up to that. But research doesn’t point to any increase in ATIs.

One final factor may be more modern — after the transition to agriculture, the genes which cause autoimmune disorders may have provided an evolutionary advantage by keeping people extra-safe in the crowded, pathogen-rich environments of early settlements. And we’re seeing an overall increase in autoimmune disorders of every kind recently as more of the slack is taken away from our immune systems by drugs, making it liable to react out of proportion to perceived threats.

The bottom line is that we don’t really know where gluten intolerance stems from yet.

As for the other disorders, their causes vary quite a lot and may not even be understood or still debated in some cases. If you think you may have a form of gluten sensibility, speaking to a physician is your best way of getting more information.

Cool stuff gluten can do for you

You can still have some fun with gluten, even if you can’t eat it. Candia on Instructables has a nice guide set up so you can make some at home. The cream of tartar will make the dough more elastic, but even if you take it our of the mix the gluten is strong enough to keep the play-dough in one piece no matter how you stretch it. It’s basically dough so you don’t have to worry about the kids (or yourself) sneaking a bite out of it — but be mindful of intolerance.

If you’d rather feel like gluing your kids to the wall (I don’t judge), Wheatglue can come in handy. It’s as easy as mixing flour and water, as Instructabler theRIAA shows. It’s one of the oldest glues ever, used since antiquity to bind books and in the more modern art of plastering posters. Plus, it’s biodegradable so the little ones will come off on their own after some time.

This is not chicken — seriously. It’s seitan, which is basically gluten. The broccoli is just broccoli. Image credits: John / Flickr.

You can use gluten as an alternative to tofu (seitan) and will likely appreciate its more robust texture and stronger aroma compared to the subtle soy product. And as a bonus for vegetarians, you’ll finally have a go-to answer for when people ask where you get your protein from. It even looks a lot like meat, and it’s much healthier than tofu.

So is gluten right for you? Well, statistically speaking, probably yes.